What is the difference between sports injuries in adults and children?

In general, the field of sports injuries is wide and includes traumas, such as strains and fractures, injuries that occur due to excess training such as stress fractures, head traumas and even effects on the body’s hormonal axes and sexual development.
Sports injuries in children are a subcategory of such injuries, and they are different than injuries in adults simply because children are not small adults.
The main difference between adults and children is the fact that children grow. In addition to being softer and weaker, their bones also have regions of growth in their ends called growth plates (epiphysis and apophysis). These areas are more prone to injury due to the mechanical characteristics of bones. Injury in those areas, can, in the worst-case scenario, lead to a full or partial cessation of growth, which can lead to differences in the length of limbs, deformities in the limb, a limp or even dislocation of a joint.
Due to the need for accurate and guided therapy in these types of fractures, monitoring and management by a pediatric orthopedist is recommended, both in the acute phase – to determine the need for casting, splinting or surgical treatment, and also in the later phase – to monitor the development and growth of the limb in a symmetrical manner.
An additional difference that distinguishes pediatric injuries from adult injuries is associated with the soft tissues in children: the tendons, ligaments, muscles and cartilage.
At a young age, most of these components are more flexible than what they are in adulthood and therefore this puts them at a greater risk of joint dislocation, imbalance and strains. On the other hand, some of these components are even stronger than bones, and therefore injuries to thighs in an adult can cause a tear in the ligaments (such as a tear in the anterior cruciate ligament ACT), and in children can lead to an avulsion fracture (such in the tibial eminence).

Examples of common sports injuries in children

Osgood-Schlatter disease injury

One of the most common injuries that I see among young athletes (usually football or basketball). This injury manifests with pain in the front of the shin, close to the knee, in the region where the pica tendon connects.
The injury is characterized by pain, swelling and tenderness in the front of the proximal shin. The pain is experienced mainly during physical exertion or following physical exertion, persists for several hours and resolves by the next training session.
The child reports tenderness and swelling in the area and difficulties with flexing the knee (squats). The child usually also finds it difficult to sit on their knees.
The pain stems from the inflammation that develops in this relatively weak area, where the pica tendon connects to the shin, and from the body’s attempt to reduce the inflammation that has developed there.
How are Osgood-Schlatter injuries treated? Usually by reducing the intensity of the training session and physiotherapy, with an emphasis on stretching exercises. Sometimes a special knee dressing, cooling down the knee or use of anti-inflammatory medication can be useful. The child sometimes ends up with a bony bump in the proximal shin that makes it difficult for them to sit on their knees also in adulthood.
Since Osgood-Schlatter is very common in children, we have dedicated an entire chapter to it and I invite you all to read it.

Meniscal tear in the knee

Another common injury that we should elaborate on because of the need for quick and accurate therapy.
Meniscal injuries are not specific to children, but in contrast to adult athletes, meniscal tears in children can sometimes be managed with a suture that retains the meniscus rather than a debridement – which removes the entire torn part from the knee.
In children the potential for healing is better but the timing of the suture has to be as early as possible in order to improve the chances of healing.
When an athlete reports a circular injury to the knee followed by a loud “puck” sound, with development of swelling and a locked knee – meaning the knee is unable to straighten or flex, there is a concern for bucket handle tear type meniscal injury, which should be diagnosed and managed promptly.
In these situations, I recommend a knee MRI as soon as possible in order to detect the injury promptly and manage it in the operating room as needed.
There isn’t a specific period of time for management but we know that the longer the meniscus is detached the more difficult it is to suture it back in and the less suitable it is for debridement, which leaves the trainer with a smaller sized meniscus in their knee.

What about hormonal effects in children that train at a professional level?

An additional “sports injury” associated with children only is the effect on the body’s hormonal axis, which can have a detrimental effect on growth and other systems.
Children, and girls in particular, that train at high intensities, expose their bodies to significant stress for extended periods of time.
As a response to this stress, their body secretes certain hormones such as cortisol, which are responsible for coping with stress in an optimal way, but when secreted chronically, depress other systems that are associated with growth, bone density, sexual development and may even lead to psychological disorders.
How can you avoid this?
Parents need to be aware of the dangers and risks and keep track of any changes in behaviour, learning, growth or sexual development. In addition, it is important to make sure the child trains in an organized way and follows specific programs that allow periods of time of rest during the year, instead of high intensity practice throughout the entire year without any rest.
And of course, if any questions arise, consulting your pediatrician is always the right way to go.

How do you prevent sports injuries in children and teenagers?

Prevention of injuries is a growing field in orthopedics and together with other fields, there has been an attempt to reduce the risks of acute injuries, especially those due to overuse.
For example, young football players in professional leagues enjoy different protocols of training that are meant to strengthen the neural feedback mechanism in order to reduce the risks of injury with falling, tackling or jumping.
Trainers and sports doctors learn and teach their children and parents about the number of daily and weekly hours of training, the restrictions of training and weight-lifting and also receive assistance from nutritionists and sleep doctors in order to make sure young athletes are able to gain the maximum from the hours during which they are not on the field.
In summary, as a pediatric orthopedist that specializes in sports injuries, I prefer watching your children play and train than see them at my office.
Nonetheless, and in any case of injury related to sports, please see a pediatric orthopedist that specializes in this field in order to get prompt and thorough treatment.